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INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
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RECEIVED va
TO: CLERK OF THE BOARD
worm JUN 29-2020
FROM: Terri Ysaguirre MARICOPA COUNTY
SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS
DATE: 6/22/2020
Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next
available Board agenda
Vv The attached item(s) have been researched to ensure that the warrant(s) in question have
not been cashed or previously re-issued.
Vv The original warrant(s) have had a stop payment done.
If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at
terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent
of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor)
Thank you.
#21 Murphy Elementary Education Technology Consortium $125.00
Schools Affidavit/Claim Form
Application for a Duplicate Warrant/ Check (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
EDUCATION TECHNOLOGY CONSTIUM (1), peing first sworn, upon oath deposes and says:
Name/Claimant
On or about OO lo 9/2020 (date)(2) a warrant/check was issued to the
above named person/éntity ih the amount as stated below. — Such warrant/check was
either never received or was subsequently inadvertently lost or destroyed and there is
no reasonable probability of its being found or presented for payment, or it was not
presented for payment within one year after the date of issuance.
Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement
warrantichec be issued to him/her in the sum of $ 125.00 (3)
Signed: [ ne, VY fd Uy (4)
— ¢
an and sworn,to before me this LT _ aay of SUNE 20 FQ
Ow deN fea
NOTARY PUBLIC
~~ PAULAL. GILBERT
A Notary Public - State of Arizona
} COCONINO COUNTY
255
My commission expires: X My Commission Expires
/ (-[{-~AOAO _ November 11, 2020 (seal)
Note, Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued,
Warran Check Number r
pees 3700270403 “PD PROVED
Original Date of Issue é
(if known) (7) 01 /09/2020 “ 21/2024
Reason for original issue of Warrant/Check (8): =
1 Payroll FRAN McCARROLL _!
Xx For Services or Goods furnished Confrenee
(1 Other: ;
$:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A,R.S. 11-632 & 15-999
NORTHERN
ARIZONA
LINIVERSITY
16 June 2020
Terri Ysaguirre
Accounting Specialist
Office of the Maricopa County School Superintendent
Barbara Gracia
Senior Account Technician
Murphy School District #21
RE: Vendor letter for replacement check request
Education Technology
Consortium
Administration:
928.523.9037 office
982.523.8901 fax
1300 S. Milton Rd., ST 212
Flagstaff, AZ 86001
UU,
Zl Sy
Co
ee
4
Please see the attached Affidavit requesting a replacement check for warrant number 3700270403. Our
department never received this check in payment for a conference registration. Claire Nyce is the Executive
Director of the Education Technology Consortium and is the authorized signer for the department.
Please contact us at 928.523.9037 with questions or if additional information is needed.
Regards,
“(ook
Robin Cook
Support Services Specialist
Education Technology Consortium